Health Risk Factors
By taking several simple steps, Virginians can improve their overall health prospects, quality of life, and longevity. Adopting a healthy lifestyle and getting regular checkups (to cover preventive tests and immunizations and to control chronic conditions) can both pay big dividends.
An unhealthy lifestyle -- one characterized by more than one health risk factor present -- often creates a host of debilitating health problems, exacts a terrible toll in suffering, and carries a hefty economic price tag. Virginia is committed to promoting healthy lifestyles, starting in childhood, to help citizens live long, productive lives.
Why is This Important?
A healthy lifestyle is one in which individuals eat nutritious foods, regularly engage in physical activity, avoid smoking and substance abuse, consume alcohol in moderation, and get regular medical checkups. Immunizations are another vital tool for maintaining health -- a line of defense against some of the most deadly infectious diseases known. Living an unhealthy lifestyle often results in lost workdays, lower productivity, and negative health outcomes, including chronic disease; it also strains private and government health care resources. Adults with more than one unhealthy behavior are nearly seven times more likely to report having poor or fair health than those with no unhealthy behaviors.
How is Virginia Doing?
The USDA Center for Nutrition Policy and Promotion's Dietary Guidelines for Americans recommends a balanced diet for adults that contains 2-3.5 cups of vegetables and 1.5-2.5 cups of fruit per day. However -- at best -- fewer than 15 percent of Americans comply with this advice. Based on frequency of intake (rather than quantity of consumption), results from the CDC Behavioral Risk Factor Surveillance System (BRFSS) indicate that many people fail to eat a single serving of fruit or vegetable each day.
In 2013, 62.6 percent of Virginians reported consuming one or more servings of fruit per day and 78.6 percent consumed one or more servings of vegetables per day. These percentages were higher than the national averages of 60.8 percent and 77.1 percent, respectively, and ranked Virginia 18th best for each measure. These percentages were also higher than peer states North Carolina (57.7% and 77.6%) and Tennessee (55.2% and 75.7%); Maryland was higher for fruit consumption (64.1%), but slightly lower for vegetables (78.0%). The nation's leader for fruit consumption was California (69.6%). Oregon placed first for vegetable consumption (83.7%).
The US Department of Health and Human Services's Physical Activity Guidelines for Americans recommends that adults need at least 150 minutes of moderate-intensity aerobic activity/75 minutes of vigorous-intensity exercise and two or more days of muscle-strengthening activities each week. Among Virginians, 22.6 percent of adults reported in 2014 that they met that standard. This rate was above the national average of 20.5 percent and ranked 12th among US states. Maryland (21.6%), North Carolina (19.1%), and Tennessee (12.2%) were lower. Colorado was the leading state at 26.7 percent.
However, some adults reported participating in no physical activity during the previous month. Among Virginians in 2014, 23.5 percent reported getting no exercise within the past month, higher than the national average of 22.7 percent. Peer states Tennessee (26.8%) and North Carolina (23.2%) were higher, while Maryland (21.4%) was lower. The national leader was Colorado at 16.4 percent.
Within Virginia, the Southside (30.0%) and Southwest (29.2%) regions reported the highest rates of physical inactivity in 2012, the latest year for which data is available; the Northern region reported the lowest (17.5%).
Being overweight or obese typically results from an energy imbalance that involves eating too many calories and not getting enough physical activity to use those calories up. After two consecutive years of decline, Virginia's obesity rate rose in 2014, to 28.5 percent; however, this is still below 2011's 29.2 percent rate and about one percentage point lower than the latest national average (29.6%).
Virginia's rate was also lower than its peer states: Maryland (29.6%), North Carolina (29.7%), and Tennessee (31.2%). Colorado, which has led the nation in lowest obesity rates since 2000, again led in 2014 with 21.3 percent.
Within Virginia, obesity rates rose in every region except the West Central and Central regions in 2014. The Eastern region had the highest obesity rate at 39.2 percent, followed by the Southside region at 36.9 percent. The Northern region had the lowest rate of obesity at 21.2 percent.
Obesity often begins in childhood and is difficult to change once it has been established. The CDC's 2013 Youth Risk Behavior Surveillance System (YRBSS) found that 26.7 percent of Virginia's high school students were overweight or obese, a decrease since 2011 of 1.6 percentage points. This figure puts Virginia below the national average of 30.3 percent and ranks the state 20th best in the country for percentage of overweight or obese children. Virginia's rate was lower than Tennessee (32.3%) and North Carolina (27.7%), but higher than Maryland (25.8%). Utah was again lowest in the US at 17.5 percent.
One metabolic complication of poor diet and obesity is diabetes. In 2014, Virginia's self-reported diabetes rate was 9.7 percent, slightly lower than the 10 percent national rate, ranking the state 21st lowest. Virginia's rate was also lower than peer states Tennessee (13.0%), North Carolina (10.8%) and Maryland (10.1%). Utah had the lowest diabetes incidence at 7.1 percent.
Virginia's regional patterns with obesity are similar to other health risk measures: The Northern region has the lowest diabetes rate at 7.2 percent, while the Southside (13.8%), Eastern (12.8%), and Southwest (12.3%) have the highest. As of 2012 (most recent data available for localities), every region except the Northern one largely continued to see diabetes incidence rise; however, state-level data from 2014, which shows dropping diabetes rates in Virginia from 2013 on, suggests that regional rates have also declined in the years after 2012.
Smoking is the second most important risk factor in early death. In 2014, Virginia's adult smoking rate of 19.5 percent was higher than the national average and ranked the state 31st in the nation. The percentage of people smoking in Virginia in 2014 was lower than in Tennessee (24.2 percent), but higher than in North Carolina (19.1 percent) and Maryland (14.6 percent). Utah led the nation with an adult smoking rate of 9.7 percent.
The Virginia Foundation for Healthy Youth recently reported that the percentage of high school students in Virginia who are regular smokers has declined from 28.6 percent in 2001 to 8.2 percent in 2015.
Excessive alcohol consumption and substance abuse are also top 10 risk factors for early death. Heavy drinking is defined as two or more alcoholic drinks a day for a man and one or more for a woman (both of average weight and height for their respective genders). Virginia's self-reported heavy drinking rate was 5.3 percent in 2014, slightly below the national average of 5.9 percent. Among peer states, Maryland had the same heavy drinking rate at 5.3 percent, while North Carolina (5.1%) and Tennessee (4.1%) were lower. At 3.3 percent, Utah reported the lowest rate of heavy drinking by adults in 2014.
Substance abuse is a growing problem in Virginia and elsewhere in the country. In 2014, 980 Virginians died from drug overdose, up from 856 in 2013. Most of these deaths were caused by prescription painkillers and heroin. The problem is growing rapidly in the state's rural regions, including Southwest Virginia.
Excluding marijuana, Virginia's rate of substance abuse for the heaviest user group (18-25 year olds) was lower than the national average. Virginia's drug use rate dropped to 5.5 percent in 2014, compared to the nationwide rate of 6.6 percent. Virginia's rate was also lower than peer states North Carolina (7.3%), Tennessee (6.4%), and Maryland (6.2%). Wyoming had the lowest rate of reported substance abuse in 2014 at 4.6 percent.
Virginia's vaccination rate for children has fluctuated in the past decade, within a range of 70 to 82 percent. More recently, Virginia's child vaccination rate rose from 74.6 percent in 2013 to 79.3 percent in 2014 -- above the national average and lifting Virginia's national rank to 9th best. Maine had the highest child immunization rate in 2014 at 87.3 percent. Virginia's rate was higher than Tennessee (72.6%) and Maryland (77.8%), but lower than North Carolina (83.0%). The national immunization rate stood at 74.6 percent.
Data from the Behavioral Risk Factor Surveillance Survey (BRFSS) shows that influenza vaccination rates in adults age 65 years and older declined from 63.3 percent in 2011 to 59.2 percent in 2014. After dropping from 72.0 percent in 2011 to 65.7 percent in 2012, pneumonia vaccinations rebounded to a new high of 73.4 percent in 2014.
What Influences Health Risks?
A healthy lifestyle -- including proper nutrition, regular physical activity, and avoidance of risky behaviors -- plays by far the most important role in determining health outcomes. The choice to adopt beneficial behaviors is itself influenced by a host of other factors, including individual personality and temperament, family and social networks, access to regular preventive care, media messages, the availability of healthful or harmful products (e.g., fresh fruits and gym facilities vs. drugs and firearms), the physical environment, and genetics.
Socioeconomic status is a major factor in the adoption of a healthy lifestyle. Educational attainment is linked with good health behaviors, in part because more educated individuals are more knowledgeable about the health consequences of an unhealthy lifestyle. Those with higher educational attainment also tend to have higher incomes, benefit from employer-sponsored health insurance, and enjoy ready access to a wide variety of healthful foods.
Primary and secondary public school investments also play an important role in promoting healthy behaviors. Developing the cognitive and non-cognitive skills which influence lifestyle decisions well into adulthood is one aspect; so are the lessons directly imparted about healthy living, as well as the type of healthful eating modeled in school-provided meals.
Lower-income areas typically suffer from a less beneficial physical and social environment, including higher incidences of crime, violence, and substance abuse. The phenomenon of "food deserts" -- where fresh and nutritious foods are not readily available or affordable without traveling long distances -- are also associated with poorer communities, even those located in bustling and prosperous cities.
What is the State's Role?
Although adopting a healthy lifestyle is ultimately the choice of each individual, states are able to influence public health behaviors in a variety of ways.
- Planning and Coordination. The state can play an important role in promoting healthy lifestyles by the development of an aggressive, coordinated strategic plan for healthy living. For example, through Virginia's Plan for Well-Being, the Virginia Department of Health is developing partnerships with local communities, schools, and medical providers to develop local initiatives to improve nutrition and physical activity.
- Education. State and local health agencies help educate the public about the importance of healthy lifestyles and direct them to other resources available for health promotion. Marketing and media campaigns target disease prevention and educate the public about health issues such as smoking, diet, and illegal drugs. Because many health behaviors take root during childhood, public schools are able to influence the adoption of healthy lifestyles through their provision of nutritious meals, restriction of access to unhealthy foods, and mandating participation in physical and health education.
- Infrastructure. Through its funding of transportation infrastructure and parks, states can affect the physical layout of communities, including walkability and accessibility of parks and recreation facilities. Research indicates that these features enhance the likelihood of physical activity. Local zoning regulations also have an effect on the built environment, including the availability of mixed-use developments that affect the jobs-population balance, time spent walking, and length of commuting by vehicle.
- Access to Preventive Care. Under the Affordable Care Act (aka Obamacare), every insured individual must be provided the basics of preventive care -- an annual physical and routine screenings and tests -- free of charge, including no patient co-pays. One way the Commonwealth can improve health behavior is by reducing the number of uninsured residents who now lack access to such preventive care. Local health departments do provide certain disadvantaged individuals with some preventive services -- including immunizations and screenings for infections and chronic medical conditions, as well as counseling and education sessions on topics such as such as smoking cessation and nutrition.
- Tax and Regulatory Policy. States may use their tax, subsidy, and regulatory powers to decrease the attractiveness of harmful products and increase the availability of good ones. All of these strategies have in fact been used to good effect in changing health behavior. For example, states tax cigarettes and alcohol at higher rates than other goods and services, while regulatory policies restrict tobacco advertising, put prominent health warnings on alcohol and tobacco products, and prohibit the sale of tobacco and alcohol to youth. By enforcing laws designed to protect public safety (e.g., drunk driving penalties), states are also able to deter many individuals from engaging in risky behaviors.
State rankings are ordered so that #1 is understood to be the best.
Data and Definitions
Adult Diet, Exercise, Obesity, Smoking, Alcohol Use, and Vaccination Coverage
State and Regional Data: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey (BRFSSS) Data. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2013.
- Diet: Consumed fruit one or more times per day; consumed vegetable one or more times per day
- Physical Activity, 2013: Participated in enough aerobic and muscle strengthening exercises to meet guidelines (i.e., at least 150 minutes per week of moderate-intensity aerobic activity, or ≥75 minutes of vigorous-intensity aerobic activity and muscle-strengthening activities at least two times per week)
- Physical Activity, 2011-2014: Participated in any physical activities during the past month
- Obesity: Body Mass Index (BMI) of 30.0 or over
- Diabetes: Ever been told by a doctor that you have diabetes?
- Alcohol: Heavy drinkers (adult men having more than two drinks per day and adult women having more than one drink per day)
- Adult Vaccination: Adults aged 65+ who have had a flu shot within the past year; adults aged 65+ who have ever had a pneumonia vaccination
NOTE: Estimates / comparisons before 2011 were dropped due to sampling methodology changes.
High School Obesity
State Data: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance System (YRBSS)
High School Smoking
Virginia Foundation for Healthy Youth, Virginia Youth Health Survey
- Illicit Drug Use Other Than Marijuana in the Past Month (18-25 year olds)
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2012- 2014.
- Drug Overdose Deaths
Centers for Disease Control and Prevention, Injury Prevention and Control: Opioid Overdose
Centers for Disease Control and Prevention (CDC)
Estimated vaccine coverage with 4:3:1:3:3:1, which includes: 4 or more doses of Diphtheria, Tetanus & Acellular Pertussis Vaccine (DTaP); 3 or more doses of Poliovirus; 1 or more doses of Measles, Mumps & Rubella Vaccine (MMR); 3 or more doses of Haemophilus Influenzae Type b (Hib); and 3 or more doses of Hepatitis B Virus (HepB) and 1 or more doses of varicella vaccine.
This immunizations survey includes a margin of error ranging from 1.4 percent on national estimates and up to 9.2 percent for some state estimates; estimates / comparisons before 2011 were dropped due to sampling methodology changes.
See the Data Sources and Updates Calendar for a detailed list of the data resources used for indicator measures on Virginia Performs.